Calles v. Commissioner of Social Security

[7] 8 UNITED STATES DISTRICT COURT 9 SOUTHERN DISTRICT OF CALIFORNIA [10] 11 CHRISTINA S. C., Case No.: 24-cv-84-CAB-DDL 12 Plaintiff, REPORT AND RECOMMENDATION 13 v. FOR ORDER AFFIRMING COMMISSIONER OF SOCIAL COMMISSIONER’S DECISION AND [14] SECURITY, ENTERING JUDGMENT IN 15 COMMISSIONER’S FAVOR Defendant. [16] 17 The undersigned respectfully submits this Report and Recommendation to 18 United States District Judge Cathy Ann Bencivengo pursuant to 28 U.S.C. § 636 (b) 19 and Civil Local Rule 72.1.c. Plaintiff Christina S. C. appeals the Commissioner’s 20 denial of her application for disability benefits pursuant to 42 U.S.C. § 405 (g) and 21 requests remand to the Social Security Administration for further proceedings. See 22 Plaintiff’s Opening Brief (“Op. Br.”), Dkt. No. 12. For the reasons stated below, the 23 Court RECOMMENDS the District Judge AFFIRM the Commissioner’s decision. 24 I. 25 BACKGROUND 26 A. Plaintiff’s Application for Disability Benefits 27 On January 5, 2021, Plaintiff applied for disability insurance benefits under 28 Title II of the Social Security Act (“Act”) and for supplemental security income 1 under Title XVI of the Act. See Certified Administrative Record (“AR”) [Dkt. No. 2 9] at 73-75.1 Plaintiff alleged she had been unable to work since June 16, 2019 due 3 to various mental and physical impairments. Id. After her application was denied 4 at the initial stage and upon reconsideration, Plaintiff requested a hearing before 5 an administrative law judge (“ALJ”), which took place on January 18, 2023 before 6 ALJ Kim Field. Id. at 50-72 . Plaintiff appeared with counsel and gave testimony. [7] Id. The ALJ issued an unfavorable decision on February 1, 2023, having concluded 8 Plaintiff “has not been under a disability, as defined in [the Act], from June 16, 9 2019, through the date of [the] decision.” Id. at 30, 41 . On November 21, 2023, the 10 Appeals Council denied review, and the ALJ’s decision became final. See id. at 111 3. This appeal timely followed. 12 B. Summary of ALJ’s Findings 13 A person is considered “disabled” within the meaning of the Act if they 14 suffer from a medically determinable physical or mental impairment which is 15 expected to last at least a year and is of such severity that they cannot work, 16 considering their age, education, and work experience. See 42 U.S.C. § 423 (d). The 17 ALJ followed the sequential five-step evaluation set forth in the regulations in 18 adjudicating Plaintiff’s disability claim.2 See generally AR at 29-42. [20] 1 The Court uses the parties’ pagination of the AR. All other docket citations [21] are to the CM/ECF page numbers. [22] 2 The five-step sequential evaluation is the same for both disability insurance [23] benefits and supplemental security income. See 20 C.F.R. § 404.1520 ; id. § 416.920. 24 The ALJ must determine the following: at step one, whether the claimant is 25 engaged in substantial gainful activity; at step two, whether the claimant suffers from a severe impairment within the meaning of the regulations; at step three, [26] whether the impairment meets or is medically equal to an impairment identified [27] in the Listing of Impairments; at step four, the claimant’s residual functional [28] 1 At step one, the ALJ found Plaintiff had not engaged in substantial gainful 2 activity after August 3, 2019. Id. at 31. Although Plaintiff alleged a disability onset 3 date of June 16, 2019, the record demonstrated she worked full-time work through 4 August 3, 2019 and that her earnings which met the threshold for substantial 5 gainful activity.3 Id. at 32. 6 At step two, the ALJ found Plaintiff had the following severe impairments: 7 depression and anxiety.4 Id. 8 At step three, the ALJ found Plaintiff’s impairments did not meet or 9 medically equal a listed impairment. Id. at 33-34. In making this finding, the ALJ 10 assessed Plaintiff’s functioning in the four “Paragraph B” categories.5 Based on 11 the evidence in the record, the ALJ determined Plaintiff had a moderate limitation 12 in understanding, remembering or applying information; a moderate limitation in [14] their past relevant work; at step five, whether the claimant can make an [15] adjustment to other work. If the claimant is found not disabled at any step, the 16 analysis does not proceed to the next step. [17] 3 Plaintiff also worked at McDonald’s in 2022 (during her period of alleged 18 disability), but her earnings were “not at the substantial gainful activity level.” Id. 19 at 32. 20 4 The ALJ found Plaintiff’s alleged physical impairments (high blood pressure, brain aneurysm, sleep apnea, knee and leg “problems,” congestive heart [21] failure, sleep apnea and “bladder issues”) were not severe. AR at 32. Plaintiff does [22] not challenge these findings. [23] 5 In addition to the five-step sequential evaluation, where a claimant alleges a 24 mental impairment, the ALJ must also rate the claimant’s degree of limitation in 25 four functional areas (understand, remember, or apply information; interact with others; concentrate, persist, or maintain pace; and adapt or manage oneself), using [26] a five-point scale (none, mild, moderate, marked, and extreme). See 20 C.F.R. [27] § 404.1520a; id. at § 416.920a. This analysis is interchangeably referred to as the [28] 1 interacting with others; a moderate limitation in concentrating, persisting or 2 maintaining pace; and a moderate limitation in adapting or managing herself. See 3 AR at 33-34. The ALJ concluded the Paragraph B criteria were not satisfied 4 because Plaintiff did not have at least two “marked” limitations or one “extreme” 5 limitation. Id. at 34. 6 Proceeding to step four, the ALJ determined Plaintiff could: [7] perform a full range of work at all exertional levels but with the 8 following nonexertional limitations: she is able to perform simple, 9 routine tasks and make simple work-related decisions[;] . . . occasionally interact with supervisors, coworkers and the public[;] [10] [and] . . . occasionally deal with changes in a work setting. [11] 12 AR at 35. The ALJ stated the foregoing RFC “reflect[ed] the degree of limitation 13 . . . found in the ‘Paragraph B’ mental function analysis.” Id. 14 In addition to the Paragraph B results, the ALJ also considered Plaintiff’s 15 subjective testimony regarding her limitations in formulating the RFC. AR at 3516 39. Having reviewed the medical records and Plaintiff’s statements regarding her 17 daily activities, the ALJ found although Plaintiff’s medically determinable 18 impairments could reasonably be expected to cause her alleged symptoms, 19 Plaintiff’s allegations regarding the intensity, persistence and limiting effects of 20 her symptoms was “not entirely consistent with the medical evidence and other 21 evidence in the record.” Id. at 36. 22 The ALJ also reviewed the medical opinions in the record. AR at 37, 39. The 23 ALJ found the opinions of two state agency psychological consultants were 24 partially persuasive. Id. at 39. The ALJ found these opinions “well supported and 25 consistent with other evidence,” and supported the RFC and the ultimate finding 26 that Plaintiff was not disabled; however, the ALJ also noted the record contained 27 evidence the consultants did not have available at the time of their respective 28 / / / 1 reviews. Id. The ALJ found the medical opinion of A. Morin, APRN6 was not 2 persuasive, as it was neither supported by objective findings nor consistent with 3 other evidence in the record. Id. at 37. The ALJ also noted Morin’s opinion 4 “rel[ied] on complete acceptance of the claimant’s allegations” as to the limiting 5 effects of her impairments, which the ALJ had already discounted. Id. 6 At step four, the ALJ concluded Plaintiff was unable to perform any of her 7 past relevant work as a nurse aide, fast food worker and hospital cleaner. AR at 8 40. At step five, the ALJ determined an individual of Plaintiff’s age, education, 9 work experience, and RFC would be able to perform jobs which exist in significant 10 numbers in the national economy. Id. Accordingly, the ALJ concluded Plaintiff 11 was “not disabled” within the meaning of the Act. Id. at 41. 12 II. 13 ISSUES PRESENTED 14 Plaintiff raises two issues on appeal: 15 1) Whether the ALJ erred by failing to reconcile her mental findings in 16 the “B” criteria at steps two and three of the sequential evaluation process with the limitations she assessed in the RFC determination; [17] and [18] 2) Whether the ALJ’s RFC determination is legally erroneous and [19] unsupported by substantial evidence, because the ALJ failed to 20 properly evaluate the opinion of treating source Amy Morin, 21 APRN. 22 See Op. Br. at 9. [24] 25 6 An Advanced Practice Registered Nurse is an acceptable medical source “for impairments within his or her licensed scope of practice.” See 20 C.F.R. [26] § 420.1502(a)(7); id. at § 416.902(a)(7). The Court assumes Morin’s scope of practice [27] is mental health, given her additional certification as a Psychiatric-Mental Health [28] 1 III. 2 STANDARD OF REVIEW 3 The Court’s review of the Commissioner’s final decision is “highly 4 deferential.” Kitchen v. Kijakazi, 82 F.4th 732 , 738 (9th Cir. 2023).7 The Court “will 5 disturb the denial of benefits only if the decision contains legal error or is not 6 supported by substantial evidence.” Id. “Substantial evidence is such relevant 7 evidence that a reasonable mind might accept as adequate to support a conclusion, 8 and must be more than a mere scintilla, but may be less than a preponderance.” [9] Id. This Court must review the entire record and consider adverse as well as 10 supporting evidence. See Ahearn v. Saul, 988 F.3d 1111 , 1115 (9th Cir. 2021). The 11 Court “may not reweigh the evidence or substitute [its] judgment for that of the 12 ALJ.” Id. Moreover, “[t]he ALJ is responsible for determining credibility, 13 resolving conflicts in medical testimony, and for resolving ambiguities.” Id. If the 14 evidence is susceptible of more than one rational interpretation, the ALJ’s decision 15 must be upheld. See id. at 1115-16 . However, the Court cannot affirm “on a ground 16 upon which [the ALJ] did not rely.” Garrison v. Colvin, 759 F.3d 995, 1010 (9th Cir. 17 2014). Where the ALJ commits legal error, the Court may affirm the decision if the 18 error is harmless, meaning “it is inconsequential to the ultimate nondisability 19 determination, or that, despite the legal error, the agency’s path may reasonably 20 be discerned, even if the agency explains its decision with less than ideal clarity.” 21 Brown-Hunter v. Colvin, 806 F.3d 487, 492 (9th Cir. 2015). “[T]he burden of showing 22 that an error is harmful normally falls upon the party attacking the agency’s 23 determination.” Molina v. Astrue, 674 F.3d 1104, 1111 (9th Cir. 2012), superseded on 24 other grounds by 20 C.F.R. § 404.1502 (a). 25 / / / [27] 7 Unless otherwise noted, internal quotation marks, ellipses, brackets, [28] 1 IV. 2 DISCUSSION 3 A. The ALJ’s Residual Functional Capacity Determination Appropriately Reflects the Paragraph B Findings [4] 5 As a first charge of reversible error, Plaintiff asserts the ALJ “fail[ed] to 6 reconcile her mental findings in the [Paragraph] ‘B’ criteria . . . with the limitations 7 she assessed in the RFC determination.” Op. Br. at 10. Plaintiff further argues “the 8 RFC adopted by the ALJ failed to properly account for the moderate limitations in 9 maintaining concentration, persistence and pace, which the ALJ adopted in her 10 P[sychiatric] R[eview] T[echnique] findings, and the failure to explain this 11 discrepancy is error.” Id. at 11 . The Court disagrees. 12 A claimant’s “residual functional capacity is the most [the claimant] can still 13 do despite [their] limitations,” and is assessed “based on all the relevant evidence 14 in [the] record.” 20 C.F.R. § 404.1545 (a); id. § 416.945(a). The ALJ’s task is to 15 “translate” the claimant’s limitations into “concrete restrictions.” Stubbs-Danielson 16 v. Astrue, 539 F. 3d 1169, 1174 (9th Cir. 2008). “Moderate limitations [in the 17 Paragraph B categories] do not have to be exactly mirrored in the RFC 18 determination.” Phillips v. Colvin, 61 F. Supp. 3d 925, 939 (N.D. Cal. 2014). Instead, 19 the Ninth Circuit holds that “an ALJ’s assessment of a claimant adequately 20 captures [those] restrictions . . . where the assessment is consistent with restrictions 21 identified in the medical testimony.” Stubbs-Danielson, 539 F.3d at 1174 (finding 22 no error where ALJ limited claimant to “simple tasks” to accommodate limitations 23 related to concentration, persistence or pace). 24 The medical testimony in the record amply supports the restrictions the ALJ 25 incorporated into the RFC. See Phillips, 61 F. Supp. 3d at 940 (“The relevant inquiry 26 is whether the medical evidence supports a particular RFC finding.”). On initial 27 review, state agency consultant M. Tashner, Ed.D., noted Plaintiff had “difficulties 28 with memory, concentration” and “authority,” and did not “handle stress or 1 change well,” but could “follow written instructions” and was able to “manage” 2 personal care, medications, chores, driving and shopping. See AR at 80. Dr. 3 Tashner opined Plaintiff was “[c]apable of understanding instructions at least 2-3 4 steps,” noting Plaintiff’s abilities with regard to concentration, persistence and 5 pace “varie[d] with motivation and interest, but capable of 1-2 steps.” Id. Due to 6 her “[d]ifficulties socially,” Dr. Tashner further opined Plaintiff “would do better 7 in low stress environment with limited social interactions.” Id. On reconsideration 8 review, state agency consultant M. Becker, Ph.D., concurred with these findings 9 and recommendations. Id. at 99. Dr. Becker found the initial assessment 10 “consistent with the objective evidence and supported by other information in the 11 file,” and found additional evidence submitted after the initial review “d[id] not 12 change the previous decision,” which remained “appropriate and supported by” 13 the medical evidence in the record. Id. 14 The ALJ’s RFC limited Plaintiff to “simple, routine tasks” and making 15 “simple work-related decisions.” AR at 35. Plaintiff was also limited to only 16 occasional contact with the public, coworkers and supervisors, and only 17 occasional changes in her work setting. See id. These limitations appropriately 18 “track” the consultants’ testimony. See Kitchen, 82 F.4th at 740. Plaintiff has not 19 persuaded the Court that the ALJ’s Paragraph B findings “were not adopted into 20 – or adequately accommodated by – the RFC she adopted.” Op. Br. at 12. As in 21 Stubbs-Danielson, the ALJ incorporated “the only concrete restrictions available.” 22 Stubbs-Danielson, 539 F.3d at 1174 .8 Plaintiff complains of an “inconsistency” [24] 25 8 See also Knealy P. v. Kijakazi, No. 20-CV-0984-AJB-BGS, 2022 WL 563237 , at *25 (S.D. Cal. Feb. 24, 2022), report and recommendation adopted, 2022 WL 827119 [26] (S.D. Cal. Mar. 18, 2022) (noting Stubbs-Danielson “makes clear the ALJ is permitted [27] to translate a claimant’s limitations in concentration, persistence, or pace into [28] 1 between the Paragraph B findings and the RFC but has not identified any other 2 concrete limitations recommended by any other medical source, nor has she cited 3 any other information in the record which supports different or further work 4 restrictions to accommodate her moderate mental limitations. See Israel v. Astrue, [5] 494 F. App’x 794, 796 (9th Cir. 2012) (unpublished) (“reject[ing]” identical 6 argument that ALJ “disregarded his step-3 findings about moderate limitations” 7 where ALJ relied on medical testimony and claimant had “not shown” the ALJ 8 “failed to consider all of the evidence in the record”); see also Sandra S. v. Kijakazi, 9 No. 21CV1248-AJB-MDD, 2022 WL 3355803 , at *6 (S.D. Cal. Aug. 12, 2022), report 10 and recommendation adopted, 2022 WL 4180973 (S.D. Cal. Sept. 12, 2022) 11 (recommending affirmance where, “[l]ike in Stubbs-Danielson,” the ALJ 12 “appropriately translated Plaintiff’s limitations with concentration and pace into . 13 . . the restrictions articulated by the State agency psychological consultants”). 14 For the foregoing reasons, the Court finds Plaintiff has not established 15 harmful error with respect to whether the RFC sufficiently reflects the ALJ’s 16 finding that Plaintiff had moderate limitations in concentration, persistence and 17 maintaining pace. 18 B. The ALJ Properly Assessed APRN Morin’s Opinion 19 As a second charge of reversible error, Plaintiff asserts the ALJ’s assessment 20 of Morin’s opinion was “cursory and conclusory” and therefore “legally 21 insufficient.” Op. Br. at 16. Plaintiff further contends the ALJ’s “failure to provide 22 the requisite explanation robs both Plaintiff and the reviewing Court of the ability 23 to ascertain the foundation” for her rejection of the opinion. See id. Again, the 24 Court disagrees. [26] medical testimony that is adequate to support RFC restrictions — an opinion that [27] identifies the concentration, persistence, and pace limitations and . . . provides the [28] 1 It is well established in this Circuit that the ALJ “need not take every medical 2 opinion at face value.” Cross v. O’Malley, 89 F.4th 1211 , 1213 (9th Cir. 2024). 3 “Rather, the ALJ must scrutinize the various – often conflicting – medical opinions 4 to determine how much weight to afford each opinion.” Id. at 1213-14 . The “most 5 important factors” the ALJ must consider in doing so are supportability and 6 consistency. 20 C.F.R. § 404 .1520c(a); id. § 416.920c(a). “Supportability means the 7 extent to which a medical source supports the medical opinion by explaining the 8 relevant objective medical evidence.” Woods v. Kijakazi, 32 F.4th 785 , 791-92 (9th 9 Cir. 2022) (citing 20 C.F.R. § 404 .1520c(c)(1)). “Consistency means the extent to 10 which a medical opinion is consistent with the evidence from other medical 11 sources and nonmedical sources in the claim.” Id. at 792 (citing 20 C.F.R. 12 § 404.1520c(c)(2)). In assessing a medical opinion’s persuasive value, the “ALJ 13 need only provide an explanation supported by substantial evidence.” Kitchen, 82 14 F.4th at 740. 15 The medical opinion at issue is a three-page check-the-box form titled 16 “Mental Capacity Assessment” signed by Morin on February 9, 2021. AR at 105117 53. Morin assessed Plaintiff as having “mild” limitations in all areas of 18 understanding, remembering and applying information; “mild,” “moderate,” or 19 “marked” limitations in areas concerning concentration, persistence, and 20 maintaining pace; “moderate” or “marked” limitations in areas concerning 21 adapting or managing oneself; and “marked” limitations in all areas concerning 22 interacting with others. See id. The form instructs the opinion writer their 23 assessments must be “based on [their] examination” of the claimant, and although 24 the form prompts the provider to “describe the . . . findings that support [their] 25 assessment[s],” Morin did not do so. See id. 26 The ALJ “was unable to attribute much persuasiveness to [Morin’s] 27 opinion.” AR at 37-38. First, the ALJ found the opinion was not supported by 28 signs and findings consistent with the degree of limitation alleged. Id. at 37. The 1 governing regulations provide “[t]he more relevant the objective medical evidence 2 and supporting explanations presented by a medical source are to support his or 3 her medical opinion[,]the more persuasive the medical opinion[]will be.” 20 C.F.R. 4 § 404.1520c(c)(1); id. § 416.920c(c)(1). Here, however, Morin did not cite any 5 clinical findings, test results or other objective medical evidence in support of her 6 opinion. AR at 1501-03. Because Morin’s opinion is “wholly unexplained” by any 7 reference to medical evidence, the ALJ “reasonably rejected” it. Woods, 32 F.4th at 8 793; see also Kitchen, 82 F.4th at 740-41 (“we have accepted the discounting of a 9 medical opinion set forth in a checkbox form with little to no explanation”); Ford 10 v. Saul, 950 F.3d 1141 , 1155 (9th Cir. 2020) (the ALJ “may permissibly reject check11 off reports that do not contain any explanation of the bases of their conclusions”). 12 Second, the ALJ found Morin’s opinion was inconsistent with her own 13 treatment record, citing mental health progress notes from Morin and others in her 14 practice group. AR at 37. The ALJ specifically identified Morin’s progress notes 15 dated December 2020 and January 2021 (i.e., shortly before issuing her opinion), 16 which documented Plaintiff’s “pleasant and cooperative” demeanor and 17 statement she “ha[d] friends she could rely on.” AR at 37 (citing id. at 1020-1049 ). 18 This evidence undermined Morin’s opinion that Plaintiff was “greatly functionally 19 limited,” especially in the areas of interacting with others, managing herself, and 20 “sustaining an ordinary routine and regular attendance at work.” Id. A medical 21 opinion is properly found unpersuasive where the provider assesses limitations 22 that are “contradicted [by] his own treatment records.” Stiffler v. O’Malley, 102 23 F.4th 1102 , 1107 (9th Cir. 2024); see also Jeanette R. v. Kijakazi, 620 F. Supp. 3d 1127 , 24 1143 (E.D. Wash. 2022) (noting the ALJ “is not obliged to credit medical opinions 25 that are unsupported by the medical source’s own data . . .”). 26 Third, the ALJ found Morin’s opinion relied “on complete acceptance” of 27 Plaintiff’s subjective allegations regarding her limitations, AR at 37, which the ALJ 28 had determined were not supported by the record. See id. at 36 (finding the record 1 “fail[ed] to support allegations of a debilitating . . . impairment” because the 2 objective medical evidence “indicate[d] at best, ailments that appear troublesome, 3 but do not impose limitations of such significance as to preclude sustained 4 competitive employment”). The ALJ could reasonably discount Morin’s opinion 5 for its overreliance on Plaintiff’s self-reported limitations, having found those 6 allegations unsupported. See, e.g., Turner v. Comm’r of Soc. Sec., 613 F.3d 1217 , 1223 7 (9th Cir. 2010) (finding no error where ALJ rejected opinion “based almost entirely 8 on the claimant's self-reporting”); Evenhus v. Astrue, 815 F. Supp. 2d 1154, 1160 (D. 9 Or. 2011 ) (“A physician’s disability opinion may be disregarded if it is premised 10 upon the claimant’s subjective symptoms and limitations that were properly 11 discredited.”). 12 Fourth, the ALJ found Morin’s opinion was inconsistent with other evidence 13 in the record, including “inconsistencies” in the evidence Morin “[did] not appear 14 to have been aware of.” AR at 38. This statement is followed by a lengthy 15 description of the evidence the ALJ found inconsistent with both Morin’s opinion 16 and Plaintiff’s subjective assessment of her limitations. See id. at 38-39. The ALJ 17 cited progress notes from the several-month period after Morin issued her opinion 18 documenting largely “normal” findings on mental status examinations. Id. at 3819 39 (citing id. at 1085, 1090, 1138-40, 1147, 1178-82, 1908, 1912, 1919). Although 20 Plaintiff was “tearful” or “agitated” during some visits, she was largely noted to 21 be alert, oriented, and cooperative, with no disturbances in sleep or appetite. Id. 22 (citing id. at 1085, 1138-40, 1178-82, 1908). Plaintiff was able to travel and engage 23 in activities of daily living. Id. (citing id. at 1085, 1090, 1912). The ALJ also cited 24 indications in the record that Plaintiff’s mental symptoms abated with medication 25 “when used appropriately.” Id. (citing id. at 1090, 1908, 1919). See Warre v. Comm’r, [26] 439 F.3d 1001, 1006 (9th Cir. 2006) (“Impairments that can be controlled effectively 27 with medication are not disabling for the purposes of determining eligibility for 28 [disability] benefits.”). 1 In sum, the ALJ found Morin’s opinions regarding Plaintiff’s limitations 2 were not persuasive because they were not “consistent with the evidence from 3 other medical sources and nonmedical sources in the claim.” 20 C.F.R. 4 § 404.1520c(c)(2). The ALJ’s discussion of the “inconsistencies” undermining 5 Morin’s opinion is thorough and detailed. Although that discussion is somewhat 6 intertwined with the ALJ’s analysis of Plaintiff’s subjective testimony, given 7 Morin’s reliance on Plaintiff’s self-reported limitations, this does not obscure the 8 ALJ’s reasoning. Despite Plaintiff’s protestations that the ALJ “rob[bed] . . . the 9 Court of the ability to ascertain the foundation for” rejecting Morin’s opinion, Op. 10 Br. at 19, the Court finds the ALJ’s reasoning both clear and legally sound. See 11 Stiffler, 102 F.4th at 1107 (finding ALJ did not err in rejecting “extreme limitations” 12 contradicted by the record). 13 For the foregoing reasons, the Court finds Plaintiff has not established 14 harmful error with respect to the ALJ’s evaluation of Morin’s medical opinion. 15 C. Substantial Evidence Supports the ALJ’s Conclusions 16 Having found the ALJ’s evaluation of Plaintiff’s subjective testimony is free 17 of harmful error, the Court turns to the question of whether the ALJ’s conclusion 18 is supported by substantial evidence. The Court has independently “assess[ed] 19 the entire record, weighing the evidence both supporting and detracting from the 20 [ALJ’s] conclusion.” See Ahearn, 988 F.3d at 1115. Based on this review, the Court 21 finds substantial evidence supports the ALJ’s decision, as summarized below. 22 Plaintiff’s treatment records dated between 2018 and 2022 confirm Plaintiff’s 23 diagnoses of recurrent depression and generalized anxiety disorder, with 24 associated symptoms including sadness, hopelessness, low self-esteem and 25 agitation. AR at 981, 993, 996, 1013, 1038, 1154, 1173, 1908. Notwithstanding 26 Plaintiff’s sad, anxious or tearful presentation at several visits, however, mental 27 status examinations were largely normal during this period, including findings 28 regarding memory, judgment, insight and concentration. See, e.g., id. at 645, 669, 1 983, 999, 1018, 1024, 1031, 1036, 1047, 1082, 1139, 1162, 1182, 1933. By both 2 subjective report and provider observation, Plaintiff’s symptoms improved with 3 medication and therapy. Id. at 744, 984, 989, 1016, 1090, 1162, 1911-12, 1937. 4 Results of an October 2022 neurology consult for Plaintiff’s complaints of memory 5 loss demonstrated “no obvious genitive deficits.” Id. at 1917-1921. 6 Plaintiff was hospitalized for suicidal ideation on March 3, 2020 after having 7 voluntarily discontinued all her medications. Id. at 588-93. She was discharged 8 three days later, on March 6, 2020, after resuming her medications (or starting new 9 ones) and reporting a “significant improvement in mood and resolution of [her] 10 suicidal ideation.” Id. at 609-12; see also id. at 1018 (progress note dated March 9, 11 2020 indicating Plaintiff “state[d] the medications that she was started on at the 12 hospital appeared to be helping her”). 13 On initial review, state agency consultant Dr. Tashner noted Plaintiff had 14 been diagnosed with adjustment disorder with mixed anxiety and depression as 15 early as 2018. AR at 80. Plaintiff’s treatment records reflected “intact” mental 16 status examinations, with “grossly intact” memory, concentration, and attention, 17 and Dr. Tashner noted Plaintiff improved with therapy and medication. Id. Dr. 18 Tashner assessed Plaintiff as capable of understanding simple instructions, and 19 recommended she work in a low-stress environment with limited social 20 interactions. Id. Dr. Tashner also identified a “TSS” completed by Plaintiff’s 21 ARNP who “cited significant difficulties not supported by objective evidence,” 22 specifically noting the provider had seen Plaintiff and had “not documented” the 23 “significant” issues reported in the TSS.9 Id. On reconsideration review, state [25] 9 The Court understands “TSS” refers to a trauma symptom scale (or trauma [26] symptom checklist), a questionnaire to identify potential symptoms of trauma and [27] its effect on a patient’s daily functioning. The Court further understands Dr. [28] 1 |}agency consultant Dr. Becker noted Plaintiff “had returned for more treatment for 2 mental condition and [was] receiving therapy” since the initial review. Id. at 3 1199. Dr. Becker concluded the additional, more recent medical records did not 4 ||change Dr. Tashner’s initial assessment and recommendations, which remained 5 || consistent with the objective medical evidence. Id. 6 The Court finds the foregoing is substantial evidence to support the AL]’s 7 \|RFC, the conclusion that Morin’s opinion was not persuasive, and the 8 || determination that Plaintiff was not disabled. 9 V. 10 CONCLUSION 11 For the foregoing reasons, the Court concludes the ALJ’s decision is free of 12 ||/legal error and supported by substantial evidence in the record. The undersigned 13 |}accordingly RECOMMENDS that the District Judge issue an order: (1) approving 14 adopting this Report and Recommendation in its entirety; (2) affirming the 15 ||decision of the Commissioner; and (3) directing that judgment be entered in the 16 ||Commissioner’s favor. 17 IT IS HEREBY ORDERED that any objections to this Report and 18 ||Recommendation must be filed by not later than December 16, 2024. Any 19 ||response to a party’s objections must be filed by not later than December 23, 2024. 20 || Failure to timely file objections may waive the right to raise those objections on 21 ||appeal. See Robbins v. Carey, 481 F.3d 1143, 1146-47 (9th Cir. 2007). 22 ||IT Is SO ORDERED. 23 || Dated: December 2, 2024 _— ZL 24 Tb hho wa 29 ‘Hon.DavidD.Leshner 26 United States Magistrate Judge